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	<title>四川农业大学教职工补充医疗保险互助金补助申请表</title>
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<div class="a4">
	<div class="a4_title">${fns:getConfig('university')}教职工补充医疗保险互助金补助申请表</div>
	<div class="a4_title2"><span>${fns:formatDate(mihMutualFund.createDate, "yyyy-MM-dd")}</span><strong>单位：</strong><a href="#">${mihMutualFund.officeName}</a> </div>
	<div class="a4_c">
		<table width="100%" border="0" class="tb2">
			<tr>
				<td width="22%" align="center" bgcolor="#f0f0f0"><strong>姓名（受助人）</strong></td>
				<td align="center"width="13%">${mihMutualFund.memberName}</td>
				<td width="15%" align="center" bgcolor="#f0f0f0"><strong>性别</strong></td>
				<td align="center"width="15%">${fns:getDictLabel(mihMutualFund.sex, "sex", "")}</td>
				<td width="20%" align="center" bgcolor="#f0f0f0"><strong>年龄</strong></td>
				<td align="center"width="15%">${mihMutualFund.age}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>身份证号码</strong></td>
				<td colspan="5" align="left">${mihMutualFund.idNo}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>住址</strong></td>
				<td colspan="3">${mihMutualFund.address}</td>
				<td align="center" bgcolor="#f0f0f0"><strong>电话</strong></td>
				<td>${mihMutualFund.phone}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>所患疾病病种</strong></td>
				<td colspan="5" align="left">${mihMutualFund.disease}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>有效单据张数</strong></td>
				<td colspan="2">${mihMutualFund.billNum}</td>
				<td colspan="2" align="center"><strong>有效单据总金额</strong></td>
				<td>${mihMutualFund.amount}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>详细说明</strong></td>
				<td colspan="5" align="left">
					<p>${mihMutualFund.details}</p>
					</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>部门工会意见</strong></td>
				<td colspan="5" align="right">
					<p>${mihMutualFund.officeApproveMemo}</p>
					<p align="right" >部门工会主席（签名）：${mihMutualFund.officeApproveName}

					<p align="right" >${fns:formatDate(mihMutualFund.officeApproveDate, "yyyy-MM-dd")}</td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><strong>互助金管理委员审查<br>
					小组意见</strong></td>
				<td colspan="5" align="right">
					<p>${mihMutualFund.reviewApproveMemo}</p>
					<p >审查小组负责人（签名）：${mihMutualFund.reviewApproveName}</p>
					<p align="right" >${fns:formatDate(mihMutualFund.reviewApproveDate, "yyyy-MM-dd")}</p></td>
			</tr>
			<tr>
				<td align="center" bgcolor="#f0f0f0"><p ><strong>互助金管理委员会<br>
					审批意见</strong></p></td>
				<td colspan="5" align="right">
					<p>${mihMutualFund.committeeApproveMemo}</p>
					<p > 管委会主任（签名）：${mihMutualFund.committeeApproveName}</p>
					<p align="right" >${fns:formatDate(mihMutualFund.committeeApproveDate, "yyyy-MM-dd")}</p></td>
			</tr>
		</table>
	</div>
</div>
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	<p>&nbsp; </p>
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